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Crohn's Disease

 
 
 
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Pathogenesis

  • Risk Factors for Inflammatory Bowel Disease

  • Family history of inflammatory bowel disease
  • Smoking (Crohn’s only - protective in ulcerative colitis)
  • Western diet - high fat, high sugar
  • Medications - NSAIDs, oral contraceptives
  • Not being breastfed
  • Psychological stress

Manifestations

  • Manifestations of Inflammatory Bowel Disease

  • Mouth ulcers
  • Malabsorption
  • Intestinal obstruction
  • Anorectal disease - fissures, fistulae, abscesses
  • Fistulae - anorectal, rectovaginal, enterocutaneous
  • Malignancy - small bowel or colorectal cancer
  • Extra-Intestinal

  • Dermatologic - erythema nodosum, pyoderma gangrenosum
  • Musculoskeletal - enteropathic arthritis, osteoporosis
  • Hepatic - primary sclerosing cholangitis, non-alcoholic fatty liver disease, cirrhosis, cholelithiasis (Crohn’s)
  • Renal - nephrolithiasis (calcium oxalate)
  • Ocular - uveitis, episcleritis, conjunctivitis

Management

  • Management Options for Crohn’s Disease

  • Non-Pharmacologic

  • Smoking cessation
  • Nutritional optimisation
  • Psychologic supports
  • Cancer surveillance
  • Pharmacologic

  • Steroids - prednisolone, budesonide
  • Thiopurines - azathioprine, 6-mercaptopurine
  • Methotrexate
  • TNF blockers - infliximab, adalimumab
  • Surgical

  • Anorectal disease - fistulotomy, seton insertion
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